tbuckley/cabot-search huggingface dataset:
Abstract 11726: Atrial Arrythmia Recurrence in Patients After Left Atrial Ablation is Associated With Epicardial Connections and Directly Correlated to Reduced Left Ventricular Ejection Fraction
Authors: Yaser Carcora, Emily Zhi, Smitha Murthy, Stephanie Li, Selcuk Adabag, Venkatakrishna N Tholakanahalli
Journal: Circulation (2022)

Introduction: Heart Failure with Reduced Ejection Fraction has a positive association with atrial arrhythmia incidence and recurrence. However, this has not been studied in atrial fibrillation (AF) and atrial tachycardia (AT) patients who underwent left atrial radiofrequency ablation(RFA) and were subsequently found to have epicardial connections(EC). Hypothesis: Heart Failure with Reduced Ejection Fraction was associated with an increased recurrence of atrial tachyarrythmias in patients with epicardial connections. Methods: We studied 40 consecutive patients with persistent atrial arrhythmias who underwent RFA for AF and AT at our center. Epicardial connections were determined by high density mapping, missing isochrones and activation patterns. Clinical, echocardiographic and activation mapping pattern characteristics were collected. Results: Forty patients were found to have EC (Table 1). The association of EC and echocardiographic parameters were assessed. Reduced Left Ventricular Ejection Fraction was associated with an increased recurrence of atrial tachyarrhythmias in patients due to epicardial connections((HR:1.25(1.05-1.48)) (Table 2). Conclusions: Reduced Left Ventricular Ejection Fraction is positively correlated with atrial tachyarrythmia recurrence in patients due to epicardial connections.
Abstract 11507: Role of Cardiovascular Magnetic Resonance Imaging in Covid-19 Recovered Patients
Authors: Shekhar Kunal, Prachi Bagarhatta, Girish Palleda, ANKIT BANSAL, Vishal Batra, Mradul Daga, Ashok Sharma, Kalpana Bansal, Mohit Gupta
Journal: Circulation (2022)

Introduction: Myocardial injury has been reported in up to one-third of patients with COVID-19. Cardiac magnetic resonance imaging (CMR) can detect myocardial injury and sub-clinical LV dysfunction in recovered patients with COVID-19. Hypothesis: To evaluate for cardiac involvement in recovered COVID-19 patients using CMR. Methods: A total of 30 subjects recently recovered from COVID-19 and abnormal left ventricular global longitudinal strain were enrolled. Routine investigations, inflammatory markers and CMR were done at baseline with follow-up scan at 6 months in individuals with abnormal baseline scan. Additionally, 20 age-and sex-matched individuals were enrolled as healthy controls (HCs). Results: All 30 enrolled subjects were symptomatic during active COVID-19 disease and were categorized as mild: 11 (36.7%), moderate: 6 (20%) and severe: 13 (43.3%). Of the 30 patients, 16 (53.3%) had abnormal CMR findings. Myocardial edema was reported in 12 (40%) patients while 10 (33.3%) had LGE. No difference was observed in terms of conventional LV parameters however, COVID-19 recovered patients had significantly lower right ventricular (RV) ejection fraction, RV stroke volume and RV cardiac index compared to HCs. Follow-up scan was abnormal in 4/16 (25%) with LGE persisting in 3 patients. Myocardial T1 (1284 + 43.8 ms vs 1147.6 + 68.4 ms; P&lt;0.0001) and T2 values (50.8+16.7 ms vs 42.6+3.6 ms; P=0.04) were significantly higher in post COVID-19 subjects compared to HCs. Similarly, T1 and T2 values of severe COVID-19 patients were significantly higher compared to mild and moderate cases. Conclusions: An abnormal CMR was seen in half of recovered patients with persistent abnormality in one-fourth at six months. Our study suggests a need for closer follow-up among recovered subjects in order to evaluate for long term cardiovascular sequelae.
Abstract 12371: Impact of Guideline-Directed Medical Therapy on 5-year Mortality in Patients With Newly Diagnosed Peripheral Artery Disease
Authors: Jung-Hee Lee, Ho Sung Jeon, Young In Kim, Jun-Won Lee, Young Jin Youn, Sung Gyun G Ahn
Journal: Circulation (2022)

Introduction: Current guidelines recommend that patients with peripheral artery disease (PAD) should be treated with antithrombotic agents, renin-angiotensin-system (RAS) blocker, and statin. However, the clinical impact of guideline-directed medical therapy (GDMT) on long-term mortality for newly diagnosed PAD is not clear. Objective: To investigate the prevalence of GDMT and evaluate 5-year mortality according to GDMT after PAD diagnosis. Methods: This retrospective cohort study using a nationwide health insurance claim data in Korea included patients with newly diagnosed with PAD from 2002 to 2015. GDMT was defined as the use of all drugs, including antithrombotic agents, RAS blocker, and statin, within 3 months after PAD diagnosis. The primary endpoint was all-cause mortality. Results: We finally investigate 19,561 patients with newly diagnosed PAD. Among the study population, 4,378 patients (22.4%) were categorized as GDMT and 15,183 patients (77.6%) were non-GDMT. During the 5-year follow-up duration, GDMT showed a lower incidence of all-cause mortality compared to non-GDMT (2.8% vs. 4.8%; hazard ratio [HR], 0.514; 95% confidence interval [CI], 0.424-0.623; p&lt;0.011). Even after propensity matched population, GDMT showed lower mortality rate than non-GDMT (HR 0.283; 95% CI, 0.217-0.370; p&lt;0.001). Among non-GDMT regimens, patients without both RAS blockers and statins had a higher 5-year mortality compared to GDMT (HR 5.324; 95% CI, 3.812-7.438; p&lt;0.001). Conclusions: After PAD diagnosis, GDMT was associated with a lower incidence of mortality. This large-scale retrospective cohort analysis showed insufficient prevalence of GDMT among PAD patients.
Abstract 11736: Role Alteration Predicts Post-Traumatic Stress, Anxiety and Depressive Symptoms in Parents of Infants With Congenital Heart Disease
Authors: Amy J Lisanti, Abigail Demianczyk, Quinn Ryan, Jesse Chittams, Barbara Medoff-Cooper
Journal: Circulation (2022)

Background: Parents of infants born with congenital heart disease (CHD) are at increased risk for mental health problems, including anxiety, depression, and post-traumatic stress (PTS). Few studies have examined to what extent the hospital experience influences these mental health symptoms over time. The purpose of this pilot study was to determine hospital factors predicting parent anxiety, depression, and PTS at 3 months post-discharge. Methods: A convenience sample of 28 biological mother-father dyads was enrolled consecutively from August 2018 to October 2019 from one children’s hospital in the Northeast, US. Parents were instructed to complete questionnaires, including valid and reliable instruments for mental health symptoms, within one week of their infant’s surgery and 3 months post discharge. Associations between hospital factors and each mental health symptom at 3 months post discharge were assessed using linear mixed effects models, accounting for the anticipated correlation between parents of the same infant using an unstructured covariance matrix. Separate linear mixed effects models were constructed for each mental health symptom using backward selection method. Results: For each one unit increase in parental role alteration, anxiety symptoms were estimated to be increased by 5.98 (SE + 1.60; p=0.002). Parents with at least a college education were estimated to have greater anxiety symptoms compared to parents with high school/technical school or less (10.89 + 3.75; p=0.009). For each one unit increase in role alteration, depressive symptoms were estimated to be increased (4.41 + 1.72; p=0.02). PTS was also significantly predicted by role alteration (5.06 + 1.91; p=0.02) along with timing of CHD diagnosis, with postnatal diagnosis estimated to increase PTS symptoms by 21.80 (SE + 10.07; p=0.04) units compared to prenatal diagnosis. Conclusion: Role alteration experienced by parents during their infant’s hospitalization significantly predicts anxiety, depression, and PTS symptoms 3-months after discharge. Additional factors were identified that can inform mental health screening in this population. Future interventions to enhance the role of parents during infant hospitalization may support parent mental health post discharge.
Abstract 11896: Spontaneous Heparin-Induced Thrombocytopenia Presenting as Acute Stent Thromboses Following an Acute St-Segment Elevation Myocardial Infarction
Authors: Chad Gier, Mark Jacobs, Gagan Verma, William E Lawson, On Chen, Puja Parikh
Journal: Circulation (2022)

Introduction: Spontaneous heparin-induced thrombocytopenia (HIT) is a rare clinical variant that develops without prior exposure to heparin. We present a 40-year-old man who was diagnosed with spontaneous HIT after an acute ST-segment elevation myocardial infarction complicated by multiple acute stent thromboses and left ventricular (LV) thrombus. Case: A 40-year-old previously healthy man with no known history of heparin exposure presented to our emergency department with an acute ST-segment elevation myocardial infarction. Emergent coronary angiography revealed a severely thrombotic 100% occlusion of his distal left anterior descending artery for which thrombectomy and percutaneous coronary intervention (PCI) were performed with placement of a drug eluting stent. Prior to angiography, the patient received 4000 units of unfractionated heparin and an additional 2000 units intra-arterially during the case. Labs prior to PCI revealed thrombocytopenia and HIT enzyme-linked immunoassay testing was sent. He underwent repeat angiography two additional times during his course for recurrent chest pain which both revealed acute stent thrombosis. HIT testing eventually returned positive for the presence of platelet factor 4 antibodies. A subsequent serotonin release assay returned positive, confirming the diagnosis of HIT. A transthoracic echocardiogram during his hospitalization also revealed an LV thrombus. Discussion: Heparin-induced thrombocytopenia (HIT) is traditionally diagnosed after thrombocytopenia develops 5 to 10 days after exposure to heparin. However, there have been rare reports of a spontaneous form of HIT that can occur without prior exposure to heparin. This case highlights a rare presentation of spontaneous HIT. Although infrequent, cardiologists should be aware of atypical presentations of HIT, since almost all patients will receive heparin prior to or during coronary angiography and coronary interventions. Spontaneous HIT should be considered in all patients who present with unexplained thrombocytopenia with arterial and/or venous thrombi. Failure to recognize this clinical entity could lead to potentially life-threatening thrombotic complications from further administration of heparin.
Abstract 12319: Open-Heart Surgeries Leading to Unexpected Latent Disease - A Rare Case of Disseminated Mycobacterium Chimaera
Authors: Shaitalya Vellanki, Maximillian Lee, Christa Zerbe
Journal: Circulation (2022)

Global reports describe several cases of disseminated Mycobacterium chimaera related to surgical field contamination by specific 3T heater-cooler units utilized in open cardiothoracic procedures. Eventual diagnosis leads to aggressive multidrug regimens and possible surgery, resulting in a high, yet potentially avoidable overall mortality rate. A years-long latency period between a patient’s initial exposure and clinical presentation can make this infection extremely challenging to diagnose. A 68-year-old-male with coronary artery disease (CAD) and a bicuspid aortic valve (BAV) suffered from shortness of breath and palpitations for eight years. An extensive cardiac work-up, including a cardiac MRI, revealed aortic root dilatation and significant CAD involving the left anterior descending coronary artery. The patient underwent an elective BAV repair, aortic root replacement, and single vessel coronary artery bypass surgery without any acute post-operative complications. Approximately four years later, he began experiencing fevers, night sweats, and vision changes. Eventually, he was ultimately diagnosed with disseminated M. chimaera confirmed by tissue biopsy. His treatment course of linezolid, moxifloxacin, ethambutol, and rifabutin, was complicated by adverse effects and complex resistance patterns. The complications he experienced secondary to this disease would eventually include long-standing bacteremia, encephalitis, splenic lesions, and aortic root abscess, which ultimately required open sternotomy for AV replacement and aortic root exchange. This patient remains the sole survivor from his home hospital among several other patients who also underwent cardiac surgeries and subsequently developed disseminated M. chimaera. He has since developed additional spinal involvement described as destructive osteomyelitis/discitis and confirmed via biopsy. As he continues to combat this clinically devastating bacterial pathogen, his multi-system complications with such an insidious presentation serve as a reminder to maintain a high clinical suspicion for the possibility of disseminated mycobacterial and other similar infectious processes in the differential diagnoses of all cardiothoracic surgical patients.
Abstract 11966: ﻿Dlk1 Derived Adiposity Stimulates Lipids Retention in Aortic Valve
Authors: Rihab Bouchareb
Journal: Circulation (2022)

Calcified aortic valve disease (CAVD) is the most prevalent valvular heart disease in western populations affecting nearly 2.5% of individuals over 65. Currently, there is no viable pharmacological treatment to stop the progression of the disease or to activate mineral regression. The only effective therapy to treat CAVD is surgical valve replacement or trans-catheterization. Obesity is the major common nutritional disorder worldwide and is one of the important risk factors for CAVD. It has been shown before that DLK1 -/- mice have increased abdominal adiposity. Indeed Dlk1 plays an essential role in regulating adipocytes differentiation and proliferation. Recently, it has been shown that there is an association between fat tissue accumulation and an increased risk of aortic stenosis. We hypothesize that dysregulation of DLK1 stimulates adiposity, increases circulating lipids, enhances valve lipids retention, and stimulates calcification. Herein, our objective is to examine the expression of DLK1 in calcified aortic valve and its impact on lipid retention. Method: We examined the effect of Dlk1 loss of function on lipid retention in aortic valve tissue in ApoE -/- Dlk1 -/- mice fed with a high-fat diet and in human explanted aortic valves using immuno-staining. Results: The complete deletion of DLK-1 in ApoE -/- mice were associated with an increased oxidized-LDL deposit in aortic valve tissue. In addition, circulating cholesterol (420 ± 8 mg/dl vs 250± 12 mg/dl, P=0.002) and triglyceride concentration (200 ± 3 mg/dl vs 50± 10 mg/dl, P&lt;0.001) were higher in ApoE -/- DLK1 -/- compared to apoE -/- mice. An increased valvular calcification accompanied these changes, as shown by the over-expression of RUNX2 and the increased aortic jet velocity in ApoE -/- DLK1 -/- mice. Interestingly the overexpression of DLK1 in isolated human valve cells decreased calcification and lipid retention in vitro. Conclusion: This study showed the significant role of Dlk1-derived abdominal adiposity in valve-lipid retention and calcification.
Abstract 11122: Sex Differences and Disparities in Cardiovascular Outcomes of Covid-19
Authors: Maria Bergami, Edina Cenko, Jinsung Yoon, marialuisa scarpone, Lina Badimon, Antonio David, Ilir Demiri, Dorobantu Maria, Oana Gheorghe Fronea, Radmilo Jankovic, Sasko Kedev, Nebojsa Ladjevic, Ratko Lasica, Goran Loncar, Giuseppe Mancuso, Guiomar Mendieta Badimon, Marijan Passalic, Petra Mjehovic, Davor Milicic, Milovan Petrovic, Lidija Poposka, Milena Stefanovic, Mihaela van der Schaar, Zorana Vasiljevic, Marija vavlukis, Maria Laura Vega Pittao, Vladan Vukomanovic, Marija Zdravkovic, Stefano Nava, Gaetano Caramori, Olivia Manfrini, Raffaele Bugiardini
Journal: Circulation (2022)

Introduction: Previous analyses on sex differences in case-fatality rates at population-level data had limited adjustment for key patient clinical characteristics thought to be associated with COVID-19 outcomes. Hypothesis: We aimed to estimate the risk of specific organ dysfunctions and mortality in women and men. Methods: This retrospective cross-sectional study included 17 hospitals within 5 European countries participating in the International Survey of Acute Coronavirus Syndromes (ISACS) COVID-19 (NCT05188612). Participants were individuals hospitalized with positive SARS-CoV-2 from March 2020 to February 2022. Risk-adjusted ratios (RR) of in-hospital mortality, acute respiratory failure (ARF), acute heart failure (AHF), and acute kidney injury (AKI) were calculated for women versus men. Estimates were evaluated by inverse probability of weighting and logistic regression models Results: The overall care cohort included 4,499 patients with COVID-19 associated hospitalizations. Of these, 1,524 (33.9%) were admitted to ICU, and 1,117 (24.8%) died during hospitalization. Compared with men, women were less likely to be admitted to ICU (RR: 0.80; 95%CI: 0.71-0.91). In general wards and ICU cohorts, the adjusted women-to-men RRs for in-hospital mortality were of 1.13 (95%CI: 0.90-1.42) and 0.86 (95%CI: 0.70-1.05; p interaction =0.04). Development of AHF, AKI, and ARF was associated with increased mortality risk (OR: 2.27; 95%CI; 1.73-2.98, OR: 3.85; 95%CI: 3.21-4.63 and OR: 3.95; 95%CI: 3.04-5.14, respectively). The adjusted RRs for AKI and ARF were comparable among women and men regardless of intensity of care. By contrast, female sex was associated with higher odds for AHF in general wards, but not in ICU (RRs: 1.25;9 5%CI: 0.94-1.67 versus 0.83; 95%CI: 0.59-1.16, p interaction =0.04). Conclusions: Women in general wards were at increased risk of AHF and in-hospital mortality for COVID-19 compared with men. For patients receiving ICU care, fatal complications including AHF and mortality appeared to be independent of sex. Equitable access to COVID-19 ICU care is needed to minimize the unfavourable outcome of women presenting with COVID-19 related complications.
Abstract 12243: Impacts of Obesity in Clinical Outcomes in Patients Hospitalized for Atrial Flutter
Authors: Abdulkareem O Lukan, Richard Orji, Nelson Okoh, Omofolarin Babayale, Oseiwe 'Benjamin' Eromosele, Muhammad Ahmad, Tagbo C Nduka
Journal: Circulation (2022)

Introduction: Atrial Flutter is an abnormal heart rhythm affecting the heart's upper chamber. It has comparative stroke risk to atrial fibrillation but differs in the arrhythmia's origin. There is Paucity of data comparing the relationship between obesity and atrial flutter. This study aims to bridge that gap. Methods: We analyzed the National Inpatient Sample (NIS) database from 2016 to 2019. The NIS was searched for hospitalized adult patients with atrial flutter as a principal diagnosis with and without obesity as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. The secondary outcomes were the rate of catheter ablation, cardiogenic shock (CS), cardiac arrest (CA), total hospital charge (THC), and length of stay (LOS). Multivariate logistic and linear regression analyses were used accordingly to adjust for confounders. Results: About 1,891,479 patients were admitted for Atrial Flutter, 21% (398,040) had underlying Obesity. Cohorts with Obesity vs No Obesity had a mean age of 64.4 years [CI 64.3 - 64.5] vs 72.2 years [CI 72.1 - 72.3]; male (52.4% vs 50.4%), female (47.6% vs 49.6%); white (79.8% vs 82.2%), black (11.0% vs 7.8%), and Hispanic (6.2% vs 5.9%). Compared to patients without Obesity, patients admitted with coexisting Obesity had a statistically significant decrease in mortality (0.47% vs 0.95% aOR 0.72, 95% CI 0.64 - 0.81, P 0.001), CA (0.33% vs 0.42%, P=0.003), and CS (0.58% vs 0.61%, P&lt;0.001) compared to those without obesity. The obesity cohorts also had a statistically significant increase in rates of catheter ablation (aOR 1.18, P&lt;0.001), LOS (aIRR 1.05, P&lt;0.001) and THC (aIRR 1.08, P&lt;0.001). Conclusion: Patients admitted primarily for Atrial Flutter with co-existing Obesity had lower inpatient mortality, CA, and CS. There was a statistically significant increase in the rates of catheter ablation, LOS and THC among the obese group. Additional studies are required to elaborate on the management of this patient group.
Abstract 11655: Direct Oral Anticoagulants Compared With Low Molecular Weight Heparin and Vitamin K Antagonists in the Management of Cancer-Associated Thrombosis: A Systematic Review and Network Meta-Analysis
Authors: Ali Mir, Mohammed F Rahman, Khaled M Ragab, Sarah M Elsayed, Ahmed H Fathallah, Abdulrahman I Hagrass, Ibrahim Kamal, Waseem Farooq, Ronak Bahuva, Brian Page
Journal: Circulation (2022)

Objective: Low molecular weight heparin (LMWH) has been established for the treatment of cancer-associated thromboembolism (CAT). Recent guidelines suggest Direct Oral Anti-Coagulants (DOACs) may have a role in the management of CAT, however these recommendations were conditional. This study aims to compare DOACs with LMWH and Vitamin K Antagonists (VKAs) in CAT. Methods: We conducted a meta-analysis of studies through a systematic search of four electronic databases (PubMed, Scopus, Web of Science, and Cochrane) published before January 25, 2022. Our criteria included studies in patients with all cancer types who received DOACs, VKAs, or LMWH for prevention or treatment of CAT. We analyzed outcomes including recurrent venous thromboembolism, major bleeding, clinically relevant non-major bleeding (CRNMB), and all-cause mortality. The quality assessment of the included RCTs was conducted through Cochrane Tool, while the quality of the included cohort studies was assessed by the NIH tool. The network meta-analysis was performed using the netmeta package in R software. Results: A total of 55 studies were included; 18 RCTs, and 37 cohort studies. DOACs (RR= 0.72, 95% CI [0.63; 0.83]) and LMWH (RR= 0.78, 95% CI [0.64; 0.94]) had a significantly lower risk of major bleeding than VKAs. There was also a significantly decreased risk of clinically relevant non-major bleeding (CRNMB) with LMWH than DOACs (RR= 0.63, 95% CI [0.55; 0.73]) and DOACs compared to VKA (RR= 0.83, 95% CI [0.72; 0.95]). With regards to recurrent venous thromboembolism risk (VTE), DOACs showed a significantly lower risk compared with either LMWH (RR=0.70, 95% CI [0.59; 0.83]) or VKA (RR=0.66, 95% CI [0.54; 0.80]). Conclusion: We conclude that DOACs are more effective in the management of CAT when compared to LMWH and VKA. DOACs and LMWH have significantly lower risk of major bleeding when compared to VKA. More research is needed to determine the best anticoagulation strategy for distinct types of cancers.